Patient Safety and Suitability for Primary Cleft Lip Repair as Day Case Surgery – A Systematic Review and Meta-Analysis

Abstract

Objective To perform a systematic review and meta-analysis to determine if day case cleft lip surgery has an impact on complications and 30-day readmission rate. Design A systematic review was conducted using PRISMA guidelines. Databases included; PubMed, Science Direct, Ovid and Cochrane. Search terms; “Day Case”, “Day Care”, “outpatient”, “Ambulatory” AND “Cleft”, “Cleft Lip”. Meta-analysis was performed using RevMan 5. Setting Eligible study types included; randomised controlled trials, observational studies (prospective and retrospective) and case series. Patients/Participants Paediatric patients undergoing primary cleft lip repair. Interventions Day case surgery versus inpatient admission post-operative. Main Outcome Measure(s) Primary outcome measure: Primary cleft lip repair performed as a day case in paediatric patients. Secondary outcome measures: 1. Complication rates and 30-day re-admission to hospital rate. 2. Patient suitability for day case surgery. Results Ten papers with 13 804 patients undergoing primary cleft lip repair were included, 28% were discharged on the day of surgery (Range 17%-81%). There was no significant difference in complication rate between the inpatient and day case cohorts. There was a significant reduction in 30-day readmission rates in the day case cohort. Conclusions This meta-analysis indicates there is no difference in complication rates for patients discharged on the day of surgery compared to those admitted overnight. Complications encountered were infrequent, non-life threatening and often occurred more than 24 h following discharge. There was an observed reduction in 30-day readmission rates for day-case patients. This is likely to represent a variation in baseline characteristics which deemed them suitable for day case surgery pre-operatively.